information about you and your child

Child's name :*

Child's date of birth (DAY/MONTH/YEAR):*

Child's age (at date of club):*

child's gender:

Any allergies or special dietary requirements?:

If YES, please tell us about it here (including any medications)::

Any medical or behavioural conditions, or special learning needs?:

If YES please tell us about it here (including any medications):

Doctor's Surgery:*

Surgery telephone number:*

Can your child swim at least one length of a standard pool unaided? (7+ clubs only will use the pool):

I agree to my child being included in any photos/recordings/filming. I understand that no names will be used in any marketing material.:

I consent to my child receiving first aid treatment if required:

(for ages 4-6) I consent to staff applying sun cream, which I will provide, to my child:

parent/guardian name(s):*

home address:*

postcode:*

daytime phone number:*

Mobile Number:*

email address:*

BOOKING INFORMATION:

WHICH AGE GROUP ARE YOU BOOKING FOR?:

PAYMENT METHOD: I wish to pay using::

ONLINE using BACS: Please send me the bank account details
CASH IN PERSON (please see Margaret at The Bursary, Sherborne Prep School, 39 Acreman St, Sherborne DT9 3NY)
CHEQUE (payable to Sherborne Preparatory School)
CHILDCARE VOUCHERS (please specify below)

Childcare Voucher details::

I have read and agree to the terms and conditions:

NAME:*

DATE:

DATES I WISH TO BOOK FOR::

PREFER TO COMPLETE A HARD COPY? No problem - click here to download a form then either email it to [email protected] or post/pop in to see Margaret at The Bursary, Sherborne Prep, 39 Acreman St, Sherborne, DT9 3NY